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NPI Code Detail

MEDICARE: MRS. OLGA LOUISE BOOTH MS, NCC, LGPC

MEDICARE: MRS. OLGA LOUISE BOOTH MS, NCC, LGPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP1600XPastoral CounselorLGPC #147MD

General Provider Information

NPI Number : 1285681817
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. OLGA LOUISE BOOTH MS, NCC, LGPC
Provider Business Mailing Address
First Line : 2811 DEEP LANDING RD
Second Line :
City : HUNTINGTOWN
State : MD
Zip : 20639-9586
Country : US
Telephone Number : 180-049-1536
Fax Number : 410-882-1898
Provider Business Practice Location Address
First Line : 8203 HARFORD RD
Second Line :
City : PARKVILLE
State : MD
Zip : 21234-5888
Country : US
Telephone Number : 800-491-5369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 07/08/2007

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